vomiting and sezures

I have a 4 year old daughter with a history of seizures (seizure

free for over a year) and a history of reflux (not a problem for over 2

years.) In April she had an episode of repeated vomiting.

Then, it happened again in June. Then, July 10th it started. We have

not had more than 24 hours vomit free since July 10th. She has also

had diarrhoea part of that time. She has an immuno compromised sister

who has been totally healthy through this. That virtually eliminates

the possibility that it is contagious.

My children are already gluten free. However, even the gluten free

foods are making my child sick now. The only things she can keep

down are rice crackers and chicken with rice soup. She wakes up vomiting

in the middle of the night and we are worried she is going to choke.

We have done blood work to check for food allergies and are waiting

on those results. We are going to do an x-ray just to make sure

there isn't something there. We are going to try Pepcid to ensure it's not

reflux related. Since this started she has also started seizing

again. They aren't sure which condition is causing the other, so

they are talking about a brain MRI as well.

Do you have any other suggestions of things that we can check for?

We will be doing more blood work in a few days so I want to include

anything we can so we don't have to do it again. She is a petite

child to begin with and she's already lost some weight. In our

family we often deal with "rare" things. So, even if it is rare I still

want to hear about it.

Thank you.

Chelsea

Dear Chelsea,

How very distressing this must be for you.

The combination of seizures plus vomiting would make me very keen indeed to have an MRI of her head.

Blood tests for food allergies are helpful but not conclusive and you may find that your doctor wants to withdraw a food for 3 weeks and the challenge her with it again after the 3 weeks has been completed.

Toddler Falling a lot

My 34 month old granddaughter falls a lot. Loses her balance a lot. She is very bright with no speech or hearing problems, although she failed her birth audio. but when she went back for a 2nd test,passed. My daughter took her to an ent specialist a few months ago and she failed her test in one ear, but they were puzzled by this and wanted to put her to sleep for testing. She does have flat feet and her left one turns out very slightly. This situation is of great concern to me.
Thanking you in advance.
Nancy


Dear Nancy,
I note your concern. I doubt that ear problems are connected to the falling, even though the inner ear is responsible for balance. If she does have the hearing test while asleep, find out if the hearing loss (if any) is of a conductive type. It most likely is and that would not be connected with her falling.
Flat feet at 34 months can be considered normal. Toddlers have very lax ligaments and the arch of the foot contains a pad of fat which disappears as the toddler grows older. The turned out foot is probably OK too but with the frequent falls makes me wonder if her local doctor has assessed her legs for stregth and normality of (tendon) reflexes. If these are normal, I would be prepared to wait and see. It is normal for toddlers to fall a lot so much so that they usually have bruises on the front of their legs and often on their foreheads. Falls on flat surfaces are not a worry but your daughter should be protected from falling down stairs by a gate at the head of the stairs.

Physical child abuse and neglect

I have been seeing so much about child abuse and neglect in the media lately. Why do you think this is happening so much these days? What can be done about it?

I will restrict my answer to physical abuse and neglect. This is not because sexual abuse is not important but because it is, in my opinion, a different problem for which we do not have a satisfactory answer other than gaoling the perpetrators.

At least 80% of parents who abuse their children were themselves abused as children. These parents have a very poor model of parenting and very poor self esteem. While they hated being abused and swore they would not do it when they grew up, under stress they revert to the model they experienced as children. They are, in fact, sad parents.

Of the remainder psychiatric disease, if one includes depression and alcohol and drug abuse under that heading, is the main reason. Very few abusers are simply evil people but unfortunately those that are capture most of the media attention.

At this point I should point out that if you were abused as a child it does not mean that you will become an abusive parent. 75% of abused children do not abuse as parents – a triumph of the human spirit! Also child abuse was not non-existent in the old days. It simply went unrecognised as a problem. It was not taught to me or any medical student in the nineteen fifties. There was a famous case of an abused girl who was brought to the attention of the courts at the end of the nineteenth century. The case was thrown out because a parent was totally responsible for their child. The case was brought again but under the Prevention of Cruelty to Animals act and was successful!

What can be done about it? The simply evil (bad) parents have to have their children removed and face the law. The psychiatric (mad) parents need psychiatric treatment and in many cases the children may need alternative care at least on a temporary basis.

However, the vast majority (80%) need support in their parenting and many organisations attempt to do this. In the old days family and neighbours did this but this often not available in modern society. Unfortunately, the main need is for emotional support – not budgeting, housekeeping etc (although this may also be needed)-and this takes time: more time than society can afford to pay if one uses an employed social worker, visiting nurse or any paid supporter. The most successful program was introduced by the late Henry Kempe in which he used trained volunteer mothers whose task was to “mother the mothers”. This program has been emulated in many other places around the world. I ran one such program with the high success that Kempe found but it took 20 hours per parent per month. Society simply could not afford to pay a salary for such parent-helpers given the rates of child abuse that we currently have.

In the last 50 years we have recognised the problem of physical abuse and neglect. We have learnt a lot about its causes and I think we have found a successful treatment for many cases. It is a dismal picture at the moment but I believe there is cause for hope.